A new study by Eugene DeClercq and Frances MacDorman–my favorite epidemiologists–looks at trends in home vaginal birth after cesarean (home VBAC) from 1990-2008. The results are interesting, if not surprising, given the trends in American maternity care as a whole.
Basically, Declercq et al found that home VBACs in the U.S., while still rare events, have been increasing–most recently from 664 in 2003 to 1000 in 2008. VBACs accounted for less than 1% of home births in 1996, but are now 4% of total home births. Meanwhile hospital VBACs have decreased from 3% of total hospital births in 1996 to 1% in 2008.
VBACs underwent a steep decline in the late 1990s after the American College of Obstetricians and Gynecologists came out strongly against VBACs being performed in hospitals that did not have 24/7 OB anesthesia services, in case of the need for an emergency c-section. For a small number of women–likely those with no local VBAC alternative–this simply drove VBACs out of the hospital and “underground” – ie, into the home setting.
The safety of home VBACs can (and will) be debated endlessly. The take-home point for me, though, is that this is one more reason to integrate home birth into the larger American maternity care system. Women can’t be forced to give birth in hospitals, and neither demonizing home birth nor overstating the advantages of hospital birth is doing anyone any good. (For examples of some especially vocal opposition to home birth, see the replies to Dr. Alice Dreger’s article in The Atlantic I cited a few days ago.)